Community Arts Development Program

Proposal

Page 1

DEADLINE: January 15, 2009

Community Arts Development Program

Building Sustainability

Application FY2009

PLEASE TYPEInstructions begin on page 8

1. APPLICANT GENERAL INFORMATION

a.b.c.

Applicant's Legal NameAKA Website (URL)

d.

StreetAddressStreet # / City / State / Zip Code

e.

Mailing Address (if different from street address)Street # / City / State / Zip Code

f.g.h.

Neighborhood/Borough Council District #Community Board #

i.j.k. l.

Chief Executive OfficerTitleTelephone (+ ext.)E-mail

m.n.o. p.

Contact PersonTitleTelephone (+ ext.)E-mail

q.r.s. t.

Incorporation DateFiscal Year beginsFederal ID NumberFax Number

(Month/Year)(Month/Day)

u. Briefly describe your organization’s mission and principal activities.

v. Indicate the proposed Capacity Building Project that you are applying for:

Board Development

Strategic Planning

Business Planning

Applicant’s Legal Name

l. APPLICANT GENERAL INFORMATION (continued)

w. Organization Narrative – Provide a brief history of your organization, highlighting periods of growth and change. Is the founder still involved, and if so, in what capacity? How have your constituency and/or local community changed? How has this affected your organization?

x. Community Access and Participation – Describe the characteristics of the community being reached or audience being served. Describe your organization’s involvement in and commitment to the local community (e.g., outreach, accessibility, free or reduced fees, community-based programming, volunteer opportunities, barriers to participation, collaborations, networks)

y. Fee Structure–Describe or itemize rates charged for admission, tuition, membership, workshops, classes, etc. In order to verify that your programs are affordable to low-income persons, indicate any free offerings, reduced rates, scholarshipopportunities, etc.

Applicant’s Legal Name

II. PROPOSED CAPACITY BUILDING PROJECT

a. Critical issues – Describe the specific critical issues you believe will be clarified or addressed as well as what you hope to accomplish through this project. Also indicate how the proposed project will impact your organization’s overall organizational effectiveness and sustainability. Indicate a preferred project timeline.

b. Project Determination – Provide the names and stakeholder relationships of those who participated in the organizational capacity self-assessment. Identifyany other analysis or discussion (such as board meetings, feasibility studies, benchmarking indicators, etc.) that helped you determine which particular capacity-building project is most critical for your organization at this time.

Applicant’s Legal Name

II. PROPOSED CAPACITYBUILDING PROJECT (continued)

c. Project Leadership– Identify the individual who will keep the project participants on schedule and on task. Why was this person selected? Qualifications? What is their role within the organization? What is their relationship with other participants? Who else will be on the project planning team? Identify their roles or relationship to the organization.

d. Previous Experience Regarding Change and Growth – Discuss significant/important management, administrative or capacity-building challenges to your organization over the past two years. Describe efforts you have made to address these challenges.

Applicant’s Legal Name

III. BOARD INFORMATION (to be completed by Board member)

Board Members

a. (See SupplementalInformation, Proposal page 10).

Offices, Committees, Recruitment

b. Does the board have a committee structure? Yes No If so, list all standing committees and describe how committees operate in relation to the full board.

c. Were any ad hoc committees formed during the past two years? If so, what issues, tasks, or events did they address?

d. Briefly describe board practices regarding the basic steps of board development, recruitment, orientation, and training.

Applicant’s Legal Name

III. BOARD INFORMATION (continued, to be completed by Board member)

Board Practices and Policies

e. How often does the Board meet? Monthly Quarterly Annually Other Specify:

f. Does the Board require a quorum? Yes No If so, how often is the quorum achieved?

g. Does the Board monitor and evaluate the CEO’s performance?Yes No If so, how often?

h. Does the Board evaluate itself, 1)individually?Yes No If so, how often?

2)as a whole? Yes No If so, how often?

i. Do members have term limits? Yes No Do Board officers have term limits? Yes No

j. Does the organization have written policies regarding management, communication etc? Yes No

If so, to what extent is the Board familiar with them?

k. Does the organization have an approved fiscal policies and procedures manual?Yes No

If so, to what extent is the Board familiar with such policies and procedures?

l. Indicate whether the Board has approved, written policies that address the following:

Code of Ethics: Yes No

Conflict of Interest Policy: Yes No

Whistleblower procedure: Yes No

Document retention: Yes No

m. Does the Board approve the budget prior to the beginning of the fiscal year?Yes No

Board Participation in Development

n. What percentage of board members contribute financially to the annual operating budget?

o. In the last completed fiscal year, what percentage of your organization’s total income was given by the Board?

p. What percentage of board members have contributed to or made commitments to the capital campaign?

q. What is the Board’s contribution policy?

r. Are board members involved in securing funding and other resources for the organization, from individuals and institutions? If so, how?

Applicant’s Legal Name

III. BOARD INFORMATION (continued, to be completed by Board member)

Board Support for CapacityBuilding

s. Either the Board Chair or a Board member who will champion the capacity building project must provide a statement of support in the space below. Include a description of the Board’s intended involvement in the process and any expectations for long-term benefits. Address critical challenges that the Board faces and the types of assistance that would be helpful in addressing these challenges.

Applicant’s Legal Name

IV. ANNUAL OPERATING BUDGET

IMPORTANT: Further specification is required where indicated below (*) and where budget figures differ by more than 20% from year to year. Provide information in BUDGET NOTES, page 9. Do not include any capital related budget items below.

INCOME / Last Completed
Fiscal Year / Current
Fiscal Year / Next
Fiscal Year
Earned Income
Admissions/ Box Office
Tuition/Class/Workshop Fees
Concessions
Fund-raising Events
Rental Fees
Other (Specify) *
Total Earned Income :
Unearned/Non-Government
Corporate Support
Foundation Support
Private Individual Support
Other (Specify) *
Non-Government Subtotal:

Unearned/Government

NEA
NYSCA
Other Federal/State (Specify) *
DCA
Other City (Specify)
Local Arts Councils (Specify) *
Government Subtotal:
Total Unearned Income:

TOTAL INCOME:

EXPENSES
Personnel – Administrative
- Artistic
- Technical
Equipment/Supplies
Outside Professional Services
Space Rentals/Utilities
Insurance
Travel/Transportation
Advertising/Promotion
Other Expenses (Specify) *

TOTAL EXPENSES

Surplus / (Deficit)
In Kind Support
(Specify source + type) *

Applicant’s Legal Name

V. BUDGET NOTES

Use this page to clarify budget items. As specified in the Instructions, provide information below to clarify footnoted items in Section V., including annual budget figures which differ by greater than 20% from year to year; any budget categories that ask for specific additional data (others, in kind, etc.); and any budget anomalies for which greater clarity is desired.

Applicant’s Legal Name

VI. SUPPLEMENTAL INFORMATION AND REQUIREMENTS

Include the following materials with your application. Clearly label in the upper right hand corner of each item, indicating your organization’s name and the corresponding number below.

1. Board of Directors/Trustees: Enclose a list ofall current Board members on your organization’s letterhead in the format below.

1. Staff: Enclose a list of personnel on your organization’s letterhead in the format below.

* For part time staff, provide the general number of hours of service per week or per month as appropriate

1. Volunteers: Enclosea list of volunteers on your organization’s letterhead in the format below. Briefly describe how volunteers are engaged with your organization and the service they provide.

1. Proof of Tax Exempt Status: Enclose a copy of letter from U.S. Treasury Department granting federal tax exemption under section IRS 501(c)(3) of the U.S. Internal Revenue Code.

1. Financial Statement/s:Based on your organization’s Operating Income for Fiscal Years2006 and 2007, provide the following financial documentation:

• Under $100,000: most current IRS 990
• $100,000 or over but less than $250,000: most current IRS 990 and Independent Accountant’s Review Report
• $250,000 or over: most current IRS 990 and Audited Statement.

If a financial statement for your last completed fiscal year does not exist, explain why not and include the most recent IRS 990 and a statement of long-term indebtedness.

1. Support Material: Enclose selected copies of the MOST RECENT material relating to the services that you propose to provide. This may include samples of publicity, advertising, reviews, programs, announcements, press releases, letters of community support, evaluations, etc.

Applicant’s Legal Name

VII. CERTIFICATION AND RELEASE

The undersigned certifies that: s/he is an authorized signatory of the applicant organization with the authority to obligate it and having knowledge of the information contained herein; the information presented within or as a supplement to this proposal is accurate or represents a reasonable estimate of future operations and is free of misrepresentations; the applicant organization releases the Department of Cultural Affairs of the City of New York, its employees and agents, with respect to damages to property or materials submitted in connection herewith.

Name of Chief Executive Officer / Name of Board Chairperson
Title / Title
Address / Address
City State Zip / City State Zip
Signature of Chief Executive Officer / Signature of Board Chairperson
() / ( )
Telephone Date / Telephone Date

Return THIS ORIGINAL APPLICATION, fivecopies, and all supplemental information to:

City of New York Department of Cultural Affairs

Community Arts Development Program

31 Chambers Street, 2nd Floor

New York, NY10007

TWO DELIVERY OPTIONS:

1) Hand-delivery: Monday -Friday: 9am-5pm, due by January 15, 2009

2) Metered mail: postmarked no later than January 15, 2009

CADP staff will send either an email or post card (if enclosed) upon receipt of application.

Applicant’s Legal Name

PROPOSAL CHECKLIST

January 15, 2009

CommunityArtsDevelopmentBuilding Sustainability FY2009

The following is a checklist of items that must be providedin order for the proposal to becomplete. Refer to the Guidelines and Instructions for complete details regarding the content and format of items required.

The application, both original and copies, should be printed on both sides of 8 ½” X 11” paper.

ONE copy of this completed checklist, placed on top of proposal materials

The ORIGINAL, signed and completed application form

FIVEcopies of the completed application form

SIX copies of Board of Directors/Trustees (see page 10 # 1)

SIX copies of Staff list (see page 10, # 2)

SIX copies of Volunteer list (see page 10, # 3)

ONEcopy of IRS 501(c)(3) determination letter (see page 10, # 4)

ONEcopy of each of the applicable financial documents based on your organization’s FY06 and FY07 operating

income (see page 10, #5)

Under $100,000: IRS 990

$100,000 or over but less than $250,000: IRS 990 AND Independent Accountant’s Review

$250,000 or over: IRS 990 AND Audited Statement

ONE set of printed support materials (see page 10, # 6)

Organization’s Legal Name written in the upper right hand corner of each document